PROJECT 1 - Improving Clinical Assessment of Diagnosis for Latinos The goal of this proposal is to develop and test a mixed methods approach to helping clinicians in public health psychiatric settings decrease clinical uncertainty by more accurately diagnosing patients with diverse cultural backgrounds and improving, the matching of clinical services to the needs of Latinos. Our approach combines methods from cultural anthropology with statistical methods and psychiatric epidemiology. The specific aims of this study focus on generating improved cultural formulations and diagnostic accuracy using information from qualitative and quantitative perspectives, iterating between the methods in a complementary fashion. The specific aims are to: Aim 1: Identify the information about symptoms and cultural and social context gathered in the initial diagnostic interview, that clinicians use to make determinations about three disorders: major depression, drug abuse and alcohol abuse; Aim 2: Use data from an epidemiological survey to assess the potential sensitivity and specificity of the clinical determinations identified in Aim1 in detecting the underlying diagnosis. We will test the hypothesis that clinical diagnosis is less accurate for Latino than non-Latino white patients; Aim 3: Assess clinician and patient reactions to the recommended improvements to diagnostic assessments developed in Aim 2. Using focus groups and consensus panels, prioritize the kinds of information to be collected to improve diagnostic determinations in safety net settings. Aim 4: Apply the findings of Aim 3 to make concrete recommendations to improve the efficiency and fairness of diagnostic decisions for Latino and non-Latino white population groups.